Chapter 2: Sex and the Elderly: No Laughing Matter in Religion

SUMMARY

This article provides a brief background for the study of sex and older persons. It examines the prevailing attitudes among older persons and society in general. A number of critical issues regarding sexuality in the latter years of life is addressed.     

Hope and social support utilisation among different age groups of women with breast cancer and their spouses

Objective: Social support and hope are considered positive, important contributors to psychological well-being for women with breast cancer and their spouses. Few studies examine the role of age in relation to these variables. The current study compares the relationship between social support, hope and depression among different age groups of women with advanced breast cancer and their healthy spouses.

Design: Cross-sectional sample of 150 women with advanced breast cancer and their spouses.

Main outcome measures: Social support, hope, depression and socio-demographic data. Analysis included comparison of these variables between groups of older and younger patients and their spouses. Structural equation modelling (SEM) was used to examine hope as a mediator of the relationship between social support and depression within each group (older and younger patients and spouses).

Results: Older patients and spouses reported lower levels of depression than younger ones. SEM showed that social support related directly to depression among younger women and older spouses, while hope was directly related to depression among older women and younger spouses and acted as a mediator between social support and depression.

Conclusions: Theoretical, empirical and clinical implications regarding the understanding of the role of age in coping with cancer are discussed.     

Sexual quality of life in patients undergoing coronary artery bypass graft surgery

Objectives: Despite improvements in many domains of functioning, sexual quality of life often remains impaired following coronary artery bypass graft (CABG) surgery. This study examined associations among sexual quality of life, fear of sexual activity and receiving information from providers about sexual activity in CABG patients.

Methods: Participants completed a survey assessing sexual activity, mental health and physical health at baseline (3–5-day post-surgery; n?=?60) and 2-month post-surgery (n?=?42).

Results: Sexual quality of life showed moderate difficulties at baseline and did not improve by follow-up (p values ≥0.09). At follow-up, greater patient fear was associated with lower sexual quality of life in some domains; receiving information was related to lower fear (p values ≤0.03) and greater sexual satisfaction and interest (p values ≤0.04). Suggestive of mediation, there was a significant indirect effect of information on patient fear and of patient fear on sexual interest (p?=?0.05).

Conclusions: Though data were cross-sectional, findings suggest that fears of sexual activity may play a role in lowering CABG patients’ motivation for sexual activity and that receiving information from a medical provider may assist in hastening sexual rehabilitation. Prospective and intervention studies are needed to support findings.     

Reformation,gender, and sexuality in Switzerland: two case studies

Abstract

Niklaus Manuel, active in Bern, painter, playwright, and politician, wrote a carnival play in 1525 entitled the Der Ablasskrämer [The Indulgence Seller], which stages seven women as rather aggressive propagators of the Reformation. The first case study examines this play and questions the predominant tendency among scholars to qualify Manuel's staging of women simply as a case of literary inversion. The second case study is concerned with sexual deviance among the Anabaptists of the St. Gall and Appenzell areas of eastern Switzerland in the mid-1520s. It interprets this, in line with other recent research, as an attempt to spiritualize sexuality.     

Socioemotional selectivity and psychological health in amyotrophic lateral sclerosis patients and caregivers: a longitudinal,dyadic analysis

Abstract

Objective: Socioemotional selectivity theory predicts that as the end of life approaches, goals and resources that provide immediate, hedonic reward become more important than those that provide delayed rewards. This study tested whether these goal domains differentially affected psychological health in the context of marital dyads in which one partner had been diagnosed with amyotrophic lateral sclerosis (ALS), a life-limiting disease.

Design: ALS patients (N?=?102) being treated in three multidisciplinary clinics and their spouses (N?=?100) reported their loneliness, financial worry and psychological health every 3 months for up to 18 months.

Main Outcome Measure: Psychological health composite.

Results: In multilevel dyadic models, patients and spouses had similar levels of financial worry and loneliness. Both patients and spouses had worse psychological health with higher loneliness, but only spouses had worse psychological health with higher financial worry. Significant interactions with age and disease severity indicated that older spouses were more affected by loneliness than were younger spouses, and patients with less severe disease were more affected by financial worry than patients with more severe disease.

Conclusion: The results provide good support for socioemotional selectivity theory’s implications for psychological health in a strong test of the theory.     

Paths and Pitfalls

SUMMARY

In up to two million couples ever married, one spouse has disclosed or may disclose being gay, lesbian, or bisexual. An increasing number of spouses are coming out, yet the phenomenon remains little known. Disclosing spouses generally find supporting organizations, while their heterosexual spouses find little support or understanding of their issues. Isolated, most cope alone. Dealing with sexual rejection, the challenge to the marriage, and, if they have children, spouse/parent conflicts is followed by handling questions about their own identity, integrity, and belief system. This piece describes issues that heterosexual spouses typically face and stages through which they move from survival to reconfiguring their lives whether or not they stay married. Peer support helps this process that lasts several years or more. Knowledge about spouse's concerns assists therapists working with spouses to help them resolve potentially paralyzing pain, anger, grief, or fear.     

Prospective effects of social support on internalized homonegativity and sexual identity concealment among middle-aged and older gay men: a longitudinal cohort study

Background and objectives: Middle-aged and older gay men experience higher rates of depression and anxiety compared to their heterosexual counterparts, with internalized homonegativity and sexual identity concealment known to be major stress-related contributors. This study examined the prospective effect of different types and sources of social support on internalized homonegativity and sexual identity concealment experienced among middle-aged and older gay men.

Methods: A longitudinal survey involving two waves of data collection separated by 12 months was conducted among a cohort of 186 gay-identified men aged 40 years and older.

Results: Two types of social support were found to be important. Greater baseline tangible or practical support independently predicted lower internalized homonegativity at 12-month follow-up, while greater baseline emotional or psychological support independently predicted a lower tendency toward sexual identity concealment at 12-month follow-up. Greater baseline support from community or government agencies, such as health services and support organizations, predicted higher internalized homonegativity at 12-month follow-up.

Conclusions: These findings suggest that tangible and emotional support may be beneficial in reducing internalized homonegativity and sexual identity concealment among middle-aged and older gay men. Ensuring that services provide environments that do not compound the stressful impact of stigma also appears to be important.     

The Paradoxes of Humor and the Burdens of Despair

SUMMARY

People today often express considerable despair about old age and the aging process. Older adults who experience frequent losses of connections with important persons can feel considerable despair in old age. Nevertheless, many older people retain hope in the face of situations that elicit despair and demonstrate what gerontologists call the “paradox of well being” in later life. Often, their hope is expressed in humor. This paper traces the connections among humor, hope, and religious faith in older adults. It argues that even persons who suffer from dementia can continue to express what Viktor Frankl called the “defiant power of the human spirit” through their humor.     

Positive and negative affect and well-being in cardiac patients and their spouses: the mediating role of illness representations

Objective: The aim of this study was to examine whether illness representations of control and consequences mediate the relation of cardiac patients’ affect to well-being. A further aim was to examine this indirect relationship at a dyadic level (i.e. patient and spouse). Design and main outcome measures: One hundred and four patients with a cardiovascular disease and their spouses participated in the study. Positive and negative affect was assessed at baseline; illness representations were assessed 2 months later, and physical and psychological well-being 4 months later. Results: Illness representations generally mediated the impact of patients’ and spouses’ affect on well-being, while several actor and partner effects were found. However, it was only positive affect that was indirectly related to well-being, while the representations of personal and treatment control chiefly acted as mediators. The effects were stronger for patients than spouses, as well as for physical well-being. Conclusion: The results underline the strong connection between illness-related self-regulation and the overall person/environment interaction as depicted by affect. They also indicate the need to integrate theories on adaptation to illness, with models describing adaptation of couples to stressful conditions, and specific theories about the role of emotion in adaptation to illness.     

A communal approach to sexual need responsiveness in romantic relationships

ABSTRACT

Sex is a crucial factor that impacts the quality and stability of relationships, yet many couples report recurrent sexual issues – such as discrepancies in their desired sexual frequency or levels of sexual desire – that detract from their relationship quality. This article describes how applying the theory of communal motivation from relationship science to the sexual domain of relationships can shed light onto understanding how couples can maintain desire over time, remain satisfied in the face of conflicting sexual interests, and decline one another’s sexual advances in ways that protect their relationship. We integrate a decade of research on communal motivation, sexual rejection, and responses to sexual rejection to provide a better, and more holistic, understanding of how partners can successfully balance their sexual needs to ultimately reap the powerful rewards of a fulfiling sexual connection.     

Family Therapy for Substance Use among Sexual Minority Youth: A Review of Treatment Options

Abstract

Substance use disorders are nearly twice as common among sexual minority youth (SMY) as among their heterosexual peers. Most applied literature about this population suggests interventions on either the individual or community level, and the benefits of family therapy for this population are often overlooked. The present literature review (a) outlines clinical knowledge related to sexual minority youth and substance use (e.g., prevalence rates, contributing factors), (b) discusses the importance of clinical self-awareness around these topics, and (c) outlines clinical behaviors and interventions from literature that may be employed when working with substance-using SMY and their families.     

Disclosure Experiences of Sexual Minority College Student Victims of Intimate Partner Violence

Although research on disclosure following intimate partner violence (IPV) victimization is burgeoning, sexual minority young adults’ (lesbian, gay, bisexual, queer, questioning, etc.; LGBQ+) experiences have not received equal attention. The current study employed the minority stress framework to examine disclosure experiences of LGBQ+ college students across the United States reporting physical IPV victimization within their current relationship (n = 77). Participants completed measures assessing minority stress and IPV disclosure, and answered open‐ended questions regarding the most and least helpful persons/responses to disclosure or reasons for non‐disclosure. Results indicated that approximately one‐third (35 %) of victims disclosed to at least one person, with friends being the most common recipients. Thematic analyses indicated that talking or listening to the victim was considered the most helpful response and not understanding the situation least helpful. Reasons for non‐disclosure centered on themes of the victims’ perception that the IPV was not a big deal. Quantitative findings regarding physical IPV disclosure indicated that non‐disclosers experienced greater minority stress than disclosers. The current study suggests the presence of differences between sexual minority (i.e., LGBQ +persons) and non‐sexual minority persons, as well as between LGBQ+ young adults/college students and older adults and presents a theoretical structure (i.e., minority stress framework) through which these differences may be understood.     

Gender and Age Differences in Social Skills Among Children with ADHD: Peer Problems and Prosocial Behavior

Abstract

Gender differences in peer problems and prosocial behavior among children with attention-deficit hyperactivity disorder (ADHD) were examined. Parents and teachers rated social functioning on the Strengths and Difficulties Questionnaire (SDQ) among 592 children (age 5–10?years) with ADHD and among 215 children (age 6–10?years) in a community sample. Results in the clinical group revealed significant interaction effects where older boys showed fewer peer problems than younger boys, but older girls had similar peer problems as younger girls. Teachers reported less prosocial behavior among younger girls than older girls. No gender differences in social problems emerged for the nonclinical comparison group.     

Perceived sexual self-control and condom use with primary and casual sex partners: age and relationship agreement differences in a Portuguese sample

Abstract

Objective: Consistent condom use is still not ideal. Research showed that perceived sexual self-control is associated with greater likelihood of using condoms. However, this association seems to vary according to age and relationship agreement (i.e. non-consensual non-monogamy, NCNM vs. consensual non-monogamy, CNM).

Design: Cross-sectional study with 307 heterosexual users of a dating web site for romantically involved individuals (81.8% men; M_age = 42.24, SD?=?9.65, range: 23–76 years). All individuals were in a romantic relationship (M_length = 13.47 years, SD?=?9.39).

Measures: Demographic information, perceived sexual self-control, condom use frequency (casual sex partners; primary partner in the last 3 months) and relationship agreement.

Results: Independently of relationship agreement, perceived sexual self-control was positively associated with condom use frequency with casual sex partners among younger and middle age participants, but not older ones (>49 years). Regarding the primary partner, a similar pattern emerged for CNM participants. In contrast, no significant association between perceived sexual self-control and condom use frequency with the primary partner emerged for NCNM individuals, regardless of age.

Conclusion: Our findings can inform evidence-based strategies to promote consistent condom use as an effective behaviour to prevent sexually transmitted infections, especially among older and NCNM individuals.     

Domain dimensionality and temporality of outcome expectancy for physical activity among middle-aged and older Chinese adults: A latent profile analysis

ObjectivesUsing a person-centered approach, this study aimed to identify the profiles of outcome expectancy for physical activity among middle-aged and older Chinese adults. Profiles were defined by two aspects of outcome expectancy including domain dimensionality and temporality, given the emphasis on social connectedness and the shortened future-time perception in this population.DesignCross-sectional survey design.MethodsParticipants included 300 Chinese adults aged 50 years or above, recruited in Hong Kong. Participants were asked to indicate their outcome expectancy for physical activity in physical, social and self-evaluative domains, rate the immediacy of each outcome expectancy item, and then report their physical activity for the past week. A latent class analysis was used to identify the number of profiles and profile characteristics, and to examine the predictors of the profile memberships and effects of the memberships on physical activity.ResultsResults suggested four profiles, including low, moderate, delayed-high and immediate-high expectancy classes. Temporality, rather than domain dimensionality, was essential in defining the profiles. Interdependent self-construal and future-time perception were predictive of the profile memberships. People with immediate-high expectancy were more physically active than those in other expectancy classes.ConclusionsThis study provided supporting evidence for the temporal self-regulation theory, and demonstrated the importance of immediate outcomes. More research attention in physical activity promotion should be given to the temporal dimension, especially for older adults who perceive future time as more limited. New directions to enhance outcome expectancies, especially for this population, also need further investigation.     

The Role of Male Sexual Partners in HIV Infection Among Male-to-Female Transgendered Individuals

SUMMARY

Male-to-female transgendered persons (MtF) in San Francisco have very high HIV prevalence and incidence. To explore possible sources for these high rates of HIV infection, a rapid needs assessment was conducted using two methods: (1) an interviewer-administered, mostly closed-ended survey with the male partners of MtF persons, and (2) focus groups with MtF persons. Five main themes were evident from the findings: (1) male partners of MtF persons are of all ages, races, sexual orientations, and socioeconomic backgrounds; (2) high-risk sex occurs between MtF persons and their male sexual partners, despite a high level of concern about HIV among both the male and MtF study participants; (3) drug use appears to play a role in unsafe sex between MtF and their male partners; (4) male partners of MtF persons may represent a possible bridge for HIV transmission among different populations, given that they reported sex with male and female partners, as well as transgendered partners; and (5) men engaging in receptive anal sex with MtF partners probably occurs more frequently than reported by the male participants, given the comments of MtF study participants. The results indicate a need for creative, community-based HIV prevention strategies that target the male partners of MtF transgendered persons.     

Transcendental Relationships? A Theological Reflection on Cybersex and Cyber-relationships

Abstract

Cybersex, i.e. sexual interactions through new media such as chat clients or email, is a phenomenon that combines two important developments of contemporary society: its increased mediatization through communication and information technologies (ICT), and the new importance that sexuality seems to have in many people's lives. Rather than an opposition between the offline and online world, a closer look at cybersex activities reveals a continuity between "real" and "virtual" realities. This paper proposes a theological reflection on some aspects of cybersex that have an immediate bearing on theological anthropology and its thinking about human existence in relation to a transcendent reality, God: the role of imagination, the relationship between body and mind, the transformed understanding of space and time and the dimension of play and fantasy in cybersex.     

Contemporary Myths, Sexuality Misconceptions, Information Sources, and Risk Perceptions of Bodabodamen in Southwest Uganda

This article reports findings from a study conducted among 212 private motorbike–taxi riders, locally called bodabodamen, from two study sites—a slum area and the urban center of Masaka town. Qualitative and quantitative methods were triangulated; a questionnaire, focus group discussions, in-depth interviews, case studies, and interactive workshops were all used. There were high levels of awareness of HIV, much more than sexually transmitted diseases (STDs), because many participants had closely experienced HIV/AIDS. Knowledge about sexual health contained several misconceptions, misinformation, and myths rooted in both the historical and contemporary social cultural context. Due to high illiteracy levels, bodabodamen cannot access many standard health education materials issued by government and private health organizations through the print and electronic media, as well as those published in languages other than the local vernacular. These (and possibly other) disadvantaged groups remain at risk of HIV and STDs. Especial efforts need to be made to provide appropriate health education.     

How Bad Is It? Perceptions of the Relationship Impact of Different Types of Internet Sexual Activities

Internet sex has become a ubiquitous phenomenon that is affecting couples and families. Eight scenarios (from visiting various adult web sites to having sex) involving a male or female character in a committed relationship were presented in a survey format. Participants (n = 242) rated each scenario in terms of emotional and physical involvement, amount of distraction from the primary relationship, and whether the respondent considered the scenario to be an affair. Results indicate that perceptions of internet activities differed depending on the type of internet sexual activity, although the majority of the internet sexual activities were considered to be highly emotional involving, a distraction to the relationship, and sexual in nature, though no physical contact was involved. The gender of the character in the scenario had no effect on participants' responses. Women tended to see the scenarios as being more serious than men. Clinical implications are discussed.     

Axis I anxiety and mental health disorders among stuttering adolescents

PurposeThe purpose of this study was to evaluate anxiety and psychological functioning among adolescents seeking speech therapy for stuttering using a structured, diagnostic interview and psychological questionnaires. This study also sought to determine whether any differences in psychological status were evident between younger and older adolescents.MethodParticipants were 37 stuttering adolescents seeking stuttering treatment. We administered the Computerized Voice Version of the Diagnostic Interview Schedule for Children, and five psychometric tests. Participants were classified into younger (12–14 years; n = 20) and older adolescents (15–17 years; n = 17).ResultsThirty-eight percent of participants attained at least one diagnosis of a mental disorder, according to the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; APA, 2000), with the majority of these diagnoses involving anxiety. This figure is double current estimates for general adolescent populations, and is consistent with our finding of moderate and moderate–severe quality of life impairment. Although many of the scores on psychological measures fell within the normal range, older adolescents (15–17 years) reported significantly higher anxiety, depression, reactions to stuttering, and emotional/behavioral problems, than younger adolescents (12–14 years). There was scant evidence that self-reported stuttering severity is correlated with mental health issues. There are good reasons to believe these results are conservative because many participants gave socially desirable responses about their mental health status.DiscussionThese results reveal a need for large-scale, statistically powerful assessments of anxiety and other mental disorders among stuttering adolescents with reference to control populations.Educational Objectives: The reader will be able to: (a) explain the clinical importance of assessing for mental health with stuttering adolescents, (b) state the superior method for adolescent mental health assessment and (c) state a major issue with determining the genuineness of stuttering adolescent responses to psychological assessment.